Important Information about My PRactice - WESTERVILLE THERAPY

PSYCHOLOGICAL ASSESSMENT and THERPY CONTRACT
Welcome to our practice. This document contains important information about our professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between you and your therapist.
PSYCHOLOGICAL ASSESSMENT SERVICES
Many people come to us for psychological assessment services to gain a greater understanding of their or their child’s strengths and weaknesses so that they can develop a strategy for success. The reason for assessment may include improving school performance, understanding psychological problems that are getting in the way of functioning, or obtaining documentation of disabilities.
The first step in the process is to talk with you and learn what the question is that we are trying to answer through psychological testing. We will also talk with the referring party, whether that be the school or a therapist or some other source to determine what is needed. If a psychological assessment is not needed, then we will charge time spent on the consultation at $200.00, the rate for initial consultation.
It is important to note that if the referral is for a child with learning problems or other conditions, which significantly impact learning, he or she may be eligible for a psychoeducational assessment by the public school system free of charge. Assessment at the school site is for purposes of determining if your child has a disabling condition that requires specialized instruction or related services and accommodations. You may be able to determine this by speaking with your child’s school counselor, school psychologist, administrator, or other Special Education staff member at the school. Generally, the child needs to be achieving below the average student level or in some cases below his or her ability level in order to be eligible for assessment by the school. This means that if the child is doing generally well in school, they may not be eligible for assessment regardless of other factors, such as attention problems. Also, the assessments by the school do not often include psychodiagnostic and neuropsychological assessment measures, so if these assessments are indicated, further testing outside of the school may be appropriate or necessary.

Also, it is important to note that there are benefits and risks to having a psychological assessment. The benefits include a clearer picture of the client’s strengths and weaknesses, which help in designing a plan to compensate for weaknesses by using strengths. Another benefit is that having a clearer clinical picture can inform treatment. Also, finally learning what the problem is that the person is having often helps alleviate a sense of shame and failure and may decrease significant others’ frustration. Lastly, assessment is often needed to obtain resources that are required to be available by law to individuals with disabilities.

Some of the risks involved with testing are that it can be unpleasant to sit through numerous difficult tests for several hours. The testing itself can cause some anxiety and frustration. Another risk of the assessment is that it may bring to light issues that have never been discussed, thus causing some unpleasantness and disagreement or conflict in relationships. Also, sometimes getting a clear diagnostic picture can leave the person experiencing unpleasant feelings due to stigma of having a particular problem or area of weakness. Lastly, a risk for some people is that they may not be eligible for accommodations that they are hoping they will be eligible for.
MEETINGS
I will conduct a clinical interview with the person being assessed and their family (if appropriate) for one hour to gain a great understanding of the problem and have releases signed so that I can contact the referring party if the assessment has not been self-referred. During the interview, I will be taking a family history, medical history, psychiatric history, educational history, developmental history, and trying to gain as much information about the person that can help understand the current difficulties. If a full assessment is needed, we will discuss amount of time the testing will take. For example, for a full psycho-educational evaluation, I usually meet with the student for two sessions for about two hours each. These sessions are usually held Monday through Saturday, starting mid morning, which gives optimal time for performance and parallels an average school day. Clients are encouraged to bring snacks and/or lunch with them to the appointment.

Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 48 hours advance notice of cancellation. You will be charged a fee for missing the session if canceled in less than 48 hours at a rate of $50.00.
BILLING AND PAYMENTS
Payment for the consultation to determine if the assessment is needed is required at the time of the meeting. If your insurance will be billed, you are expected to pay your copay at this time. If it is decided that a full assessment is indicated, I will contact your insurance company to determine then the first half of the payment will be due at the consultation meeting and the second half will be due at the first assessment meeting. Your therapist will not begin working on the report until payment has been made, but of course if you would like to discontinue the testing at any time, then you will receive a refund of the amount left over after paying for the time your therapist has already worked on your report and time spent doing the assessment.

If there is a need to cancel or change the appointment, this must be done 48 hours before the appointment. If the client cancels in less than 48 hours, then they will be charged the rate of $50.00 for each hour of the session that was scheduled (for example: if four hours have been scheduled, then the charge will be $200.00).
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information we release regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due.
INSURANCE REIMBURSEMENT
You should call your insurance company to find out what the coverage for the assessment may be, ask what your deductable is, what percentage they pay, and what the customary rate I (or my medical biller) will provide you with whatever information he/she can based on his/her experience and will be happy to help you in understanding the information you receive from your insurance company. If it is necessary to clear confusion, I (ort my medical biller) will be willing to call the company on your behalf and will prorate the hourly fee depending on how long it takes to clear the confusion (this fee will not be covered by the insurance company). Also, understand that sometimes what insurance companies initially quotes as coverage may not end up being what they pay. They sometimes can take a few months before making payments, so please be prepared when budgeting your finances.
CONTACTING ME
I am often not immediately available by telephone because I do not answer the telephone while with clients. You can call me at 614-698-6640 or email me at [email protected] and I will try to respond as soon as possible. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for a returned call, contact your family physician or the nearest emergency room and ask for the psychologist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.
PROFESSIONAL RECORDS
The laws and standards of our profession require that I keep treatment records. I will provide you a copy of the psychological assessment once it has been completed. I can also provide an edited version of the report for schools or testing agencies (e.g., GRE, MCAT) if you’d like personal information removed that is not applicable to the school or agency. I will discuss what is applicable as some personal history may be integral in the diagnosis and recommendations. I will work with you on presenting the information in a mutually acceptable manner.
MINORS
If you are under eighteen years of age, please be aware that the law provides your parents the right to examine your treatment records. I will try to provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will talk with you and encourage you to discuss the issue with them; otherwise I may have to notify them of my concern. In the paragraph below, I explain to your parents that we may not tell them information, even if you are engaging in high risk behavior such as drug use, risky sexual behavior, or other risky behavior, but I will work with you and your family to encourage you to discuss these issues at some point. Before giving your parents any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss. In general, what we talk about is private and I will consult you before any information is brought into family therapy, but please also let me know if there is something that you don’t want me to tell your parents and I will do his/her best to hold that confidential.
During the assessment, I will be open with information that is exchanged between family members, rather than the traditional confidentiality, but I will talk with you and your children first about discussing anything you have told me privately. Not everything is appropriate for everyone in the family to know and in some cases; information must be kept private to maintain a trusting relationship between the therapist and minor. I will tell you if your child is in danger, but your child may not discuss high-risk behavior unless I make it safe. This means that I may not report substance use, risky sexual behavior, or other risky behaviors right away. I will work with your child in helping them to talk to you about these issues and will work with you to improve your communication with your child around these issues.
CONFIDENTIALITY
In general, the privacy of all communications between a patient and a psychologist is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions.
In most legal proceedings, you have the right to prevent your therapist from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.
There are some situations in which I am legally obligated to take action to protect others from harm, even if your therapist has to reveal some information about a patient’s treatment. For example, if your therapist believes that a child, elderly person, or disabled person is being abused, he/she must file a report with the appropriate state agency.
If I believe that a patient is threatening serious bodily harm to another, your therapist is required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, the therapist may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.
Lastly, if you are threatening serious harm to yourself your therapist may have to break confidentiality. Your therapist will discuss this with you and we may look at the option of hospitalization if your therapist is concerned that you are in danger of committing suicide.
These situations have rarely occurred in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.
I may occasionally find it helpful to consult other professionals about a case. During a consultation I will make every effort to avoid revealing the identity of the patient. The consultant is also legally bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless he/she feels that it is important to your work together.
Lastly, we will review the assessment report together and decide who you would like to have see the report. Often, it is very helpful for therapists to have all the information in a report, while schools may not need all the family history details. Once everyone has reviewed the report, we can decide who will see it and if any changes need to be made before it goes to another party. This does not mean that your therapist can withhold information important to the understanding of the problem, but we can omit information that may not seem relevant.
This document attempts to outline all the policy and procedures involved in having Dr. Sandra Webster conduct a psychological assessment. It is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.